Orthopedic Footwear

Does Medicare Cover Orthopedic Shoes?

There are several types of orthopedic shoes and many types of covered products for leg braces. If they are an integral part of a covered leg brace, Medicare will cover:

Oxfords
High tops
Depth inlays
Custom shoes for non diabetics

If they are also medically necessary for the proper functioning of the brace, Medicare will cover:

Heel replacements
Sole replacements
Shoe transfers

Patients with partial foot amputations can have their prosthetic shoes covered if they are an integral part of the prosthesis.

Some of restrictions that apply to coverage include:

The billing for the shoe and brace must come from the same supplier.
A properly detailed order for the prosthesis must be signed and dated by the treating physician.
The order for the prosthesis must be kept on file with the supplier in the event in needs to be made available to the Durable Medical Equipment (DME) Medicare Administrative Contractor (MAC).

Shoes, inserts, and modifications for patients with diabetes are covered under Medicare's Diabetic Footwear policy.

How Much Do You Pay for Orthopedic Shoes?

You pay for 20% of the Medicare approved amount under Medicare Part B.

You must pay a $135 deductible for any Medicare Part B services and supplies before Medicare begins to pay its share. If a doctor, health care provider or supplier does not accept assignment; the amount you pay may be higher. It is extremely important that your supplier is a participating supplier in the Medicare Program. If a supplier of your durable medical equipment (DME) does not accept assignment there is no limit to what you may be charged. You may also have to pay the entire bill (including Medicare's share) at the time you get your DME.

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